Evaluating the Impact of Cardiopulmonary Bypass Priming Fluids on Bleeding After Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis.

OBJECTIVES: Cardiopulmonary bypass (CPB) predisposes young children to coagulopathy. The authors evaluated possible effects of CPB priming fluids on perioperative bleeding in pediatric cardiac surgery. DESIGN: Meta-analysis and systematic review of previously published studies. SETTING: Each study was conducted in a surgical center or intensive care unit. PARTICIPANTS: Studies investigating patients <18 years without underlying hematologic disorders were included. INTERVENTIONS: The authors evaluated randomized controlled trials (RCTs) published between 1980 and 2020 on MEDLINE, EMBASE, PubMed, and CENTRAL databases. The primary outcome was postoperative bleeding; secondary endpoints included blood product transfusion, mortality, and safety. MEASUREMENTS AND MAIN RESULTS: Twenty eligible RCTs were analyzed, with a total of 1,550 patients and a median of 66 patients per study (range 20-200). The most frequently assessed intervention was adding fresh frozen plasma (FFP) to the prime (8/20), followed by albumin (5/20), artificial colloids (5/20), and blood-based priming solutions (3/20). Ten studies with 771 patients evaluated blood loss at 24 hours in mL/kg and were included in a meta-analysis. Most of them investigated the addition of FFP to the priming fluid (7/10). No significant difference was found between intervention and control groups, with a mean difference of -0.13 (-2.61 to 2.34), p = 0.92, I2 = 69%. Further study endpoints were described but their reporting was too heterogeneous to be quantitatively analyzed. CONCLUSIONS: This systematic review of current evidence did not show an effect of different CPB priming solutions on 24-hour blood loss. The analysis was limited by heterogeneity within the dataset regarding population, type of intervention, dosing, and the chosen comparator, compromising any conclusions.

Furanocoumarins in celery and parsnips: method and multiyear Canadian survey.

The natural occurrence of biologically active furanocoumarins in common vegetables is an area of increasing interest with respect to human health. In this study, an efficient, rugged, and sensitive liquid chromatographic method with ultraviolet photodiode array detection was developed for the estimation of 5 biologically active furanocoumarins (psoralen, bergapten, xanthotoxin, trioxsalen, and angelicin) in celery and parsnips. When authentic samples were spiked with a mixture of furanocoumarins at individual levels of 2 to 10 microg/g, the method produced overall recoveries of 77 and 75% of all furanocoumarins from celery and parsnips, respectively. The method was applied in 2 laboratories to a multiyear survey of more than 200 samples. Of 110 parsnips samples, 109 (99%) contained quantitatable levels of furanocoumarins. The mean level of total furanocoumarins in the positive parsnip samples was 15.1 microg/g; the maximum level detected was 145 microg/g. Of 114 celery samples, 88 (77%) contained quantitatable levels of furanocoumarins. The mean level of total furanocoumarins in the positive celery samples was 1.9 microg/g; the maximum level detected was 15.2 microg/g. Xanthotoxin and bergapten were the most commonly detected furanocoumarins in both celery (68 and 63%) and parsnips (97 and 96%). Xanthotoxin had the highest mean level of positives in both celery (1.3 microg/g) and parsnips (8.5 microg/g). Little year-to-year variation in either total furanocoumarin levels or incidence was noted.

Determination of Penicillium roqueforti toxin by reversed-phase high-performance liquid chromatography.

A method for the detection and quantification of Penicillium roqueforti toxin (PRT) using reversed-phase high-performance liquid chromatography has been established. The limit of quantitation of this method was 3 ng of PRT, while the limit of detection was 2 ng of toxin. The precision of the analysis based on numerous runs was good. Retention times for PRT were highly reproducible with an average coefficient of variation of about 1.6%. Analysis of PRT in liquid and solid samples showed no interference of the sample matrix. The accuracy of the method was 98.6%, with mean PRT recoveries of 96.8%, and 100.4% for the spiked culture medium and blue cheese extracts, respectively.

Yield of review of systems in a self-administered questionnaire.

BACKGROUND: Family physicians frequently screen new patients with questionnaires that include a standard review of systems. The diagnostic yield of such questionnaires is unknown. METHODS: We retrospectively compared results of 248 patient questionnaires with the clinicians' dictated medical record in a university-based family medicine practice. Any positive responses in the review of systems section were compared with the medical record to determine whether they resulted in a new diagnosis and a therapeutic maneuver. RESULTS: The case-finding yield for the review of systems section as a whole was 10.5 percent. This yield compares favorably with other screening maneuvers in clinical practice. Individual questions had yields of 0.0 to 1.6 percent. The positive predictive value for a given yes response on the review of systems, defined as new diagnoses divided by total yes answers, was 3.3 percent. CONCLUSIONS: Compared with other case finding maneuvers in clinical practice, the review of systems questionnaire has a very acceptable yield. Its positive predictive value is low, however, and there are differences observed among physicians. Certain questions had a positive predictive value of 0.0 and could be deleted, which would produce a shortened review of systems section.